Coronavirus disease 2019 (COVID-19) can reportedly manifest as an acute stroke, with most cases presenting as large vessel ischemic stroke in patients with or without comorbidities. The exact pathomechanism of stroke in COVID-19 remains ambiguous. The findings of previous studies indicate that the most likely underlying mechanisms are cerebrovascular pathological conditions following viral infection, inflammation-induced endothelial dysfunction, and hypercoagulability. Acute endothelial damage due to inflammation triggers a coagulation cascade, thrombosis propagation, and destabilization of atherosclerosis plaques, leading to large-vessel occlusion and plaque ulceration with concomitant thromboemboli, and manifests as ischemic stroke. Another possible mechanism is the downregulation of angiotensin-converting enzyme 2 as the target action of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Acute stroke management protocols need to be modified during the COVID-19 pandemic in order to adequately manage stroke patients with COVID-19.

BACKGROUND:Purple sweet potato (Ipomoea Batatas L.) is one of the sources for anthocyanin, which promotes the health through antioxidant, anti-inflammatory, anti-cancer, neuroprotection, and anti-apoptosis activities. Oxidative stress has been shown to be the cause of apoptosis in ischemic stroke.AIM:The objective of this research was to delineate the pleiotropic effects of anthocyanin for neuroprotection during an acute stroke event.METHODS:Anthocyanin was extracted from Balinese cultivar of purple sweet potato and subsequently administered to rat models of induced ischemic stroke (labelled as treatment group), as well as a placebo (labelled as a control group). Several parameters were in turn evaluated, i.e. the activities of anti-apoptotic (Bcl-2) as well as pro-apoptotic (cytochrome c, caspase-3) molecules, and apoptosis rate. Bcl-2 levels were determined using the histochemical method, cytochrome c and caspase-3 via ELISA method, while apoptosis rate was measured by TdT-medicated Dutp-Nick End Labeling (TUNEL) assay.RESULTS:Bcl-2 expression demonstrated significantly higher Bcl-2 expression in the treatment compared with control group (median 31.2 vs. 1.1; p = 0.001). Accordingly, pro-apoptotic cytochrome c and caspase-3 levels were also found significantly lower in the treatment as opposed to control group (mean 4.17 vs. 8.06; p = 0.001; mean 3.81 vs. 8.02; p = 0.001). Ultimately, apoptosis rate was found markedly lower among treatment than control groups (mean 3.81 vs. control 21.97; p = 0.003).CONCLUSION:The results of this study indicated a significant neuroprotective effect of anthocyanin derived from Balinese cultivar of PSP. Anthocyanin was able to increase and reduce anti-apoptotic and pro-apoptotic protein levels, respectively, resulting in lesser cellular apoptotic rate when compared with placebo. The potential mechanism was thought mainly due to its anti-oxidant properties.

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Background COVID-19 infection can show various manifestation, including neurologic manifestations, such as anosmia, ageusia, or dysgeusia, and causes the neurologic disorder such as stroke, Guillain-Barre syndrome, encephalopathy, and many more. Aim To briefly review neurologic manifestation in COVID-19 infection in the Asia region (South East Asia and the Western Pacific Region). Material and methods This review uses the PRISMA statement and checklist. The source for reviewed article was performed in PubMed that were published between December 2019 to September 2020 with the latest 1 year of publication. Study titles were first screened, then reviewed by title and abstract and then the last review, we tested full text and applied eligibility criteria. Results We found a total of 9 retrieved articles from the electronic database. Among these 9 articles, 5 of them are case report, 1 case series, 1 prospective multi-center cohort study, 1 retrospective multi-center study, and 1 retrospective observational study. All articles reported confirmed COVID-19, confirmation by positive swab test using the real-time RT-PCR method, with neurologic manifestations, disorder, or syndrome on presentation or found during hospital stay. In case of neurologic disorder or syndrome, the studies reported encephalitis and ADEM, acute cerebrovascular disease, acute symptomatic seizure, and Guillain-Barré syndrome with acute cerebrovascular disease as the most common neurologic disorder associated with COVID-19 infection, followed by encephalitis. Conclusion COVID-19 also affects the brain, which may result in a global or focal neurologic manifestation. Healthcare provider treating patient with COVID-19 infection should also be aware of neurologic manifestation associated with COVID-19 infection to improve patient’s outcome. Guillain-Barre syndrome, encephalopathy, and many more. This review will briefly review neurologic manifestation in COVID-19 infection in the Asian region (South East Asia and the Western Pacific Region. A total of 9 retrieved articles from the electronic database reported confirmed COVID-19, confirmation by RT-PCR method, with neurologic manifestation, disorder, or syndrome on presentation or found during hospital stay. Healthcare provider treating patient with COVID-19 infection should also be aware of neurologic manifestation associated with COVID-19 infection to improve patient’s outcome.

BACKGROUND: The aging process can increase the incidence of dementia, such as spatial memory impairment to remember space, recognize shapes and distances. Research on dementia in mice was carried out by administering d-galactose through intraperitoneal injection, while oral d-galactose administration had not received enough attention. AIM: This study aims to prove the differences in the occurrence of spatial memory impairment in rats induced by d-galactose through two different routes, oral and intraperitoneal injection. METHODS: This study is an experimental study using a post- test control group design. The sample criteria were 20 male Wistar rats aged 12–14 weeks, weighing 200–300 g divided into two groups which are the oral and intraperitoneal injection. Spatial memory assessment based on spontaneous alternation using the Y-maze test was carried out at the end of week 8. RESULTS: In this study, the average spatial memory score after d-galactose administration in the injection group (51.572±4.388) was lower compared to the oral group (66.058±1.551). The Shapiro–Wilk normality test shows that the data are normally distributed with p > 0.05. Independent t-test showed a significant difference in the incidence of spatial memory disorders between the injection and oral groups with p = 0.010 (p < 0.05). CONCLUSION: The conclusion of this study is that d-galactose administration by oral route or intraperitoneal injection causes a decrease in spatial memory in mice. Spatial memory in the injection group was lower than in the oral group. This might be related to the decrease in synaptophysin in the hippocampus of mice due to d-galactose administration by intraperitoneal injection.